The presence of microorganisms, such as spirochetes or bacteria, for instance Helicobacter pylori, in tissue samples can be detected by histological stains such as the Warthin-Starry silver stain. The stain generally involves combining a silver nitrate solution with gelatin and hydroquinone. Since gelatin is typically a solid at room temperature, the manual stain protocol generally includes liquifying the gelatin, typically by warming it, such as in a microwave oven, prior to its use in the staining process. Generally temperatures as high as 56xc2x0 C. are used.
One existing automated histo-cytochemistry slide staining system dispenses a solid gelatin matrix. Upon heating, the gelatin matrix forms a solution. In a number of automated staining systems, however, it is preferred to dispense staining reagents that are liquid at room temperature. Such systems cannot currently employ the Warthin Starry staining approach because of the high temperature required to liquify gelatin. As a result, alternative protocols which do not require gelatin but which often are complex and time consuming are currently being used.
Therefore a need exists for simplified automated staining procedures based on the selective deposition of silver metal which can employ liquid dispensers to dispense room temperature staining reagents.
The methods of the present invention are directed to staining processes whose protocols include the use of gelatin. One specific example of such a staining process is the Warthin Starry method generally used to detect the presence of microorganisms, such as spirochetes, or other bacteria in a biological specimen. The methods described herein are particularly suited for performing automated staining processes using delivery of liquid reagents at room temperature and preferably from liquid dispensers. The methods described herein also provide advantages for staining procedures that are performed manually.
The methods of the invention include replacing gelatin, which generally requires heating to liquify or dissolve in water with non-gelling gelatin, a partially hydrolyzed gelatin. Non-gelling gelatin is soluble in water at room temperature, i.e., about 19xc2x0 Celsius (C) to about 25xc2x0 C. Furthermore, aqueous solutions of non-gelling gelatin in water are not viscous at concentrations such as those employed in the staining procedures described herein.
In a preferred embodiment of the invention, a biological specimen is stained by the selective deposition of silver metal. The staining method includes treating the biological specimen with an aqueous solution of non-gelling gelatin, a solution including a silver salt, e.g., silver nitrate, and a solution including a reducing agent, e.g., hydroquinone. The reaction of the reducing agent with the silver salt results in the formation of silver metal which is selectively deposited in some spirochetes, microorganisms or tissue abnormalities and visualizes their presence in the biological specimen.
The invention has many advantages. For example, it can be used to simplify existing manual staining protocols. It also allows the use of existing automated slide staining systems which employ liquid dispensers and room temperature dispensing to carry out staining procedures which could not be previously automated for such systems.
The invention is related to staining procedures of biological specimens.
Examples of biological specimens include, but are not limited to, tissue sections, cell cultures, nasal, vaginal, urethral smears, control samples and cytospins. In one embodiment of the invention, the biological specimen is a tissue sample, for instance a tissue sample suitable for histological staining. The biological specimen is prepared as known in the art. In one embodiment of the invention, the biological specimen is a paraffin embedded tissue section after fixation with 10% neutral buffered formalin or other fixative.
Numerous staining procedures, also referred to herein as staining protocols, staining processes, staining methods, stains or staining, have been developed to visualize cell or tissue abnormalities and to detect, identify or characterize microorganisms present in a biological specimen. During histological, cytological or histopathological staining protocols a biological specimen is contacted with staining reagents, also referred to herein as staining solutions or solutions. The sequence and amounts in which the staining reagents are added to the biological specimen depend on the particular staining procedure, as known in the art. Special stains generally include numerous steps and often are some of the most complex tests performed in the laboratory. A number of special stains have been developed for the histological analysis of tissue samples. For example, special stains exists for determining the presence of microorganisms, such as would occur in the context of pathogen invasion, colonization or contamination of a biological specimen, for instance a tissue sample. Such stains are referred to herein as histologic stains.
The invention is generally related to staining procedures which employ gelatin. In one embodiment of the invention, the staining procedure includes the selective deposition, also referred to herein as selective impregnation, with silver. In another embodiment of the invention, the staining procedure is related to detecting a microorganism, a cell or tissue abnormality or a cell or tissue component which is argyrophilic. By argyrophilic it is meant herein that the microorganism, cell or tissue abnormality or component has the property of selectively absorbing silver from a silver salt solution. Generally, staining techniques which rely on the selective impregnation with silver show, against a lighter background not impregnated with silver, a metallic silver image, typically black, which indicates and helps visualize the presence of a pathogen, microorganism, cell or tissue component or abnormality.
Stain protocols which rely on visualizing silver metal that has been selectively deposited often require combining a silver salt solution with a gelatin solution. Aqueous solutions are preferred. One suitable silver salt is silver nitrate. Other silver salts that can be employed in such procedures include but are not limited to silver acetate, silver chlorate and silver fluoride.
Without wishing to be bound by any particular mechanism, it is believed that the role gelatin plays in these stains is somewhat similar to its role in black and white photography. For example, it is believed, that gelatin serves as a protective colloid and has good coating and adhesion properties when used in photographic processes. It is also believed that some of the chemical reactions taking place during stain processes which rely on the formation of metallic silver also parallel chemical reactions which occur in developing black and white photographs. For example, such stain protocols include the addition of a reducing agent, often hydroquinone, a phenolic compound widely employed in photographic processes. As silver is reduced to its metallic state, it is believed that hydroquinone is oxidized to quinone. Examples of other suitable reducing agents include, but are not limited to catechol and other o- and p-dihydroxy or hydroxyamine aromatic compounds.
In a preferred embodiment, the staining procedure is a procedure for detecting spirochetes or bacteria. One particular organism that can be detected using the methods of the invention is Helicobacter pylori, (H. pylori), a bacterium associated with active chronic gastritis and peptic ulcers. Helicobacter pylori is discussed, for example, by Rhatigan-Drexler, K., xe2x80x9cA Comparison of Staining Methods for Helicobacter pylori,xe2x80x9d Histo-Logic, 30: 3-8 (1999), published by Sakura Finetek Inc., Torrance, Calif.
Examples of other specific microorganisms that can be detected by the methods of the invention include, but are not limited to, Staphylococcus aureus, Neisseria meningitidis, Neisseria Gonorrhoeae, Lactobacillus Acidophilus, Corynebacterium Vaginale, Clostridium diffcile, Listeria monocytogenes, and others.
The methods of the invention are suitable for other stains whose protocols call for using gelatin. For example, the invention can be used in conjunction with staining procedures for argyrophilic nucleolar organizer regions, commonly abbreviated as Ag-NORs.
A staining process particularly preferred herein is based on the Warthin Starry staining method which is frequently used to detect the presence of spirochetes. Protocols for the manual Warthin Starry stain are described, for example in Bridges, C. H. and Luna, L. G., xe2x80x9cMethods for Bacteria, Fungi, and Inclusion Bodies,xe2x80x9d Manual of Histologic Staining Methods of the Amed Forces Institute of Pathology 3rd Edition, Editor, Lee G. Luma (1968); Luna, Lee, G., xe2x80x9cMethods for Staining Helicobacter Pylori,xe2x80x9d Histopathologic Methods and Color Atlas of Special Stains and Tissue Artifacts, 216-218 (1992).
The existing protocols for the Warthin Starry staining method generally involve a gelatin solution, for example, a 5% aqueous gelatin solution. A typical procedure for preparing the gelatin solution is to combine solid (sheet) gelatin and water at a temperature high enough to dissolve the solid gelatin. For example, the gelatin is combined with water heated to 56xc2x0 C. for 15 minutes. One particular existing Warthin-Starry protocol, for example, calls for combining 10.0 grams of high grade sheet gelatin with 200.0 ml acidulated water to form a 5% gelatin solution. According to the same protocol, 1.5 ml of a 2% silver nitrate solution is combined with 3.75 ml of the 5% gelatin solution and 2.0 ml of 0.15% hydroquinone solution to form a developer solution. A tissue section to be stained is deparaffinized and hydrated after which it is impregnated with silver nitrate solution in a floatation bath at 43xc2x0 C. The impregnated section is then flooded with the developer solution and the section is allowed to develop to a light brown or yellow color. The presence of spirochetes can be ascertained under a microscope, by comparison with a control. The spirochetes appear black against a light brown or yellow background.
The invention is particularly related to automated staining processes and can be employed in a number of automated staining protocols and in conjunction with instruments, controls and software known in the art. The skilled practitioner also can employ the present invention, without undue experimentation, in conjunction with new automated staining procedures, new instrumentation, control systems and software as such are being developed.
Examples of automated equipment for carrying out the invention include the Artisan(trademark) Staining System provided by CytoLogix(trademark) Corporation, Cambridge, Mass., and systems such as those provided by Ventana Medical Systems, Biogenex, Dako, Shandon, Leica and others.
During automated procedures the biological specimen is affixed, smeared, attached, supported or otherwise provided, generally on a planar platform, such as a microscope slide. More than one specimen can be provided on a single slide. Commonly, the slide is a glass slide but slides made out of other materials that are compatible with the biological specimen and staining reagents can also be used. Optionally, the slides can be separated from one another by dividing walls, thereby preventing reagent spills from one slide to another.
In a preferred configuration such as described for the Artisan(trademark) slide staining system, discussed below, the slide is held on a rotating platform and staining reagents are dispensed from liquid dispensers held by a moving platform, for example a rotating carousel. As the liquid dispensers move into position over a desired slide, they dispense staining reagents in the amounts and in the sequence specified by the particular staining protocol. The protocols often include washing steps as well as steps for the collection of spent reagents and/or their disposal. Automated staining procedures generally are controlled by control systems integrated with computer software, as known in the art. Alternatively, slides supporting the biological specimens can move underneath a non-moving platform holding the liquid dispensers, or both platforms may rotate or otherwise move to bring a particular slide and a particular dispenser together for the dispensing operation.
The Artisan(trademark) slide staining system, sold by CytoLogix Corporation, is a particularly preferred configuration for using this invention. A slide bearing a thin biologic specimen, such as a tissue section or cells, is positioned on a rotary carousel. The carousel""s positioning is specified under computer control, according to a pre-set program specified by the operator of the instrument. A second rotary carousel for carrying reagents (in liquid dispensers) is located above the carousel for holding slides. The positioning of the second carousel is also under computer control. To dispense a desired reagent onto a specific microscope slide, the two carousels are rotated so that a dispenser holding a reagent (mounted on the upper carousel) is positioned above a desired slide. An actuator causes the dispenser to dispense reagent onto the slide. The amount and sequence of reagent applications to slides are specified by the particular staining protocol. The protocols often include washing steps, to remove reagent after the reaction has completed. The protocols also provide for the collection of spent reagent into selected containers. Automated staining procedures generally are controlled by control systems integrated with computer software, as known in the art.
Suitable liquid dispensers which can be employed in automated staining are described, for instance, in U.S. Pat. Nos. 5,645,114 and 5,316,452 to Steven A. Bogen, et al.; both are incorporated herein by reference in their entirety. A preferred liquid dispenser design is described in U.S. Pat. No. 6,092,695 to Herbert H. Loeffler, the entire contents of which are incorporated herein by reference.
The slide temperature in the automated systems discussed above is adjustable and thus the biological specimen and the staining reagents dispensed onto it can be warmed to and/or maintained at a specified temperature. However, it is preferred to dispense solutions of staining reagents at room temperature. Since at room temperature gelatin solutions are solid, they cannot be readily used in conjunction with room temperature liquid dispensing.
Alternative staining protocols, for similar microorganiams such as the Steiner procedure do not require gelatin. A manual, i.e., non-automated, protocol based on the Steiner method is presented, for example, in Luna, Lee, G., xe2x80x9cModified Steiner Technique for Spirochetes and Helicobacter Pylori,xe2x80x9d Histopathologic Methods and Color Atlas of Special Stains and Tissue Artifacts, 218-219 (1992). The Steiner technique, however, requires more steps, is more complex and takes considerably longer than the Warthin Starry process discussed above.
The methods of the invention are generally related to replacing the conventional gelatin solutions, used in existing stain protocols, with a solution of non-gelling gelatin, also referred to herein as partially hydrolyzed gelatin.
Non-gelling gelatin is hydrolyzed animal protein derived from collagen. It is produced, for example, from enzymatically modified gelatin. It has an approximate molecular weight of about 3,000 and an amino acid profile which is approximately the same as that of gelatin. Unlike gelatin, which is not soluble in cold water, i.e., water at room temperature, non-gelling gelatin is. The aqueous solutions of non-gelling gelatin of up to about 10% do not appreciably increase in viscosity. Above a concentration of about 10%, viscosity slowly increases. Solutions of about 50% concentration of non-gelling gelatin, for example, are quite viscous. Partially hydrolyzed gelatin is described in U.S. Pat. Nos. 4,147,772 and 4,338,335, both to McAleer et al., the teachings of which are incorporated herein by reference.
One specific example of non-gelling gelatin is currently available under the tradename Sol-U-Pro(copyright) and can be currently obtained from DynaGel, Inc., Calumet City, Ill. The characteristics of Sol-U-Pro(copyright) Type P, recommended for pharmaceutical applications, and Sol-U-Pro(copyright) type D, recommended for edible applications, are summarized in Tables 1-8.
In a preferred embodiment of the invention, non-gelling gelatin, preferably in an aqueous solution, is dispensed at room, also referred to herein as ambient, temperature, from a liquid dispenser, in an automated histological staining method, such as described above. As used herein, room or ambient temperature refers to a temperature range from about 19xc2x0 C. to about 25xc2x0 C. In another preferred embodiment, non-gelling gelatin is used in an automated staining method based on the formation of silver metal by reacting a silver salt with a reducing agent. In a further preferred embodiment of the invention, non-gelling gelatin is used in an automated staining process employed in the detection of spirochetes.
For example, in a protocol based on the Warthin-Starry approach developed for an automated system such as the Artisan(trademark) Staining System provided by CytoLogix(trademark) Corporation, Cambridge, Mass., the gelatin solution is formed, for example, by combining 5 g of non gelling gelatin with 100 ml of deionized water. Optionally preservatives may be added as known in the art.
In alternative embodiments, gelatin solutions employed in existing staining protocols, including manual as well as automated processes, can be replaced with non-gelling gelatin solutions. For example aqueous solutions having lower viscosity for an equivalent gelatin content can be prepared by using non-gelling gelatin.